Comparison of fluoroscopy time and procedure time of endovascular interventions with and without prior angiography...

Angiography simulator training (AST) can help to train important clinical aspects of complex angiography procedures before real patient contact. The aim of the present analysis was to synthesize the results of studies on endovascular interventions performed by interventionalists with and without AST in a meta-analysis.

A systematic literature research was performed in PubMed, Web-of-Science and CINAHL to identify all relevant studies. Inclusion criteria were original research, English language and comparison of endovascular interventions in procedure time (PT) and fluoroscopy time (FT) performed by interventionalists with and without AST. Study quality was assessed using modified Downs-and-Black-instrument (maximum 8 points). Heterogeneity-analysis (study design and I²) was determined, and fixed- or random-effects model was applied to pool the effect, mean difference (MD), from the individual studies. All analyses were performed two-sided, and the level-of-significance was 0.05.

Overall, 9 studies with 10 datasets and 7774 interventions were included. Study quality was 7 ± 0 for both PT and FT. Heterogeneity was present in the studies on PT (I² = 61%) and FT (I² = 99%), and a random-effects model was applied. MD for PT was significant with -2.63 min between the AST-group and control-group among the included studies (p = 0.02). In contrast, MD was not significant with -1.33 min between the AST-group and control-group among the included studies for FT (p = 0.21).

AST translates into an improved PT and similar FT in real interventions compared to conventional training. Angiography simulators offer a valuable, radiation-free alternative and expand training opportunities. Evidence is limited by study heterogeneity.